APE Revised Guide 2020

Republic of the Philippines

NATIONAL POLICE COMMISSION
PHILIPPINE NATIONAL POLICE
REGIONAL HEALTH SERVICE NCRPO
Camp Bagong Diwa, Bicutan, Taguig City

Physical Examination Guide for Annual Physical Examination (APE)

Rank/Name of Examinee: ______________________________________________

Signature: ______________________________________________

Office/Unit: ______________________________________________

Date Issued: ______________________________________________

a. Secure RPRMD Order for APE

b. Download the Medical Prescreen Questionnaire at www.pnp.gov.ph
1st Step c. Read the instructions carefully. Applicant must fill up the APE
Report, Medical Prescreen Questionnaire and Physical
Examination Guide for APE.
a. Proceed to RHS/DHS for Laboratory Examination as scheduled.
2nd Step b. Submit filled up Medical Prescreen Questionnaire
c. Vital signs and BMI will be taken
a. Proceed to RHS/DHS for Consultation as scheduled.
3rd Step
b. Physical Examination, Consolidation of Results and Consultation

4th Step Releasing of Final Results

PNP HS FORM NO. 2014-06 Revised 2017

2x2 colored picture with
white background and the
 Republic of the Philippines
NATIONAL POLICE COMMISSION
PHILIPPINE NATIONAL POLICE
REGIONAL HEALTH SERVICE
Camp Bagong Diwa, Bicutan, Taguig City
ALCANTARA, BERNARD B
PSMS

ANNUAL PHYSICAL EXAMINATION REPORT

CY_________
DATE: CONTROL NO.
RANK LAST NAME FIRST NAME MIDDLE NAME QUALIFIER BADGE NO.

AGE SEX CIVIL STATUS UNIT ASSIGNMENT/ADDRESS

PERMANENT HOME ADDRESS (NUMBER, STREET, CITY OR TOWN PROVINCE) CONTACT NUMBER

DATE OF BIRTH PLACE OF BIRTH DATE ENTERED SVC LENGHTH OF SVC PURPOSE OF EXAMINATION

NEXT OF KIN (Name, Relationship, Address, Contact No.)

THIS PART IS TO BE FILLED UP BY MEDICAL STAFF/ MEDICAL OFFICER

BMI: CLASSIFICATION: HEIGHT (cm) WEIGHT (kg) BLOOD TYPE COLOR OF HAIR COLOR OF EYES

WAISTLINE (in) BP(mmHg) CAR (bpm) RR (cpm) TEMP (Co)

FOR FEMALES: CXR (result) VISUAL ACUITY

OBSTETRIC SCORE G ___P ___ OD
( __ __ __ __ ) ECG (result) OS
LMP
Other Tests: Color Vision Test
________________________
MENARCHE
__________________

NSD C/S ____x

ABORTION
YOUR CARDIOVASCULAR RISK IS: PERTINENT PHYSICAL EXAMINATION FINDINGS: ENT Examination:
 Family History (hereditary)  Diabetes
 Sedentary lifestyle (inactive)  Hypertension
 Stressful life  High Cholesterol
 Overweight/Obesity  Smoking

Risk:______ of 8
 Low  Moderate  High

TREATMENT PLAN /ADVISE:

 Smoker
 Non-Smoker
 Previous Smoker
 Alcoholic Drinker
 Non-Alcoholic
 Occasional Drinker
 Previous Alcoholic

FINAL DISPOSITION/DIAGNOSIS PHYSICAL HEALTH PROFILE

(Encircle)

P1 P3
P2 P4

____________________________________________________________
EXAMINING MEDICAL OFFICER